June 06, 2018
2 min read

Hypertension in pregnancy may increase child’s risk for autism, ADHD

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Exposure to hypertensive disorders of pregnancy was associated with a small, but statistically significant, rise in offspring’s risk for neurodevelopmental disorders like autism spectrum disorder and ADHD, according to meta-analysis data.

“Overall, epidemiologic evidence examining the association between [hypertensive disorders of pregnancy (HDP)] and neurodevelopmental disorders remains largely inconsistent, and residual or unmeasured confounding is of particular concern in the literature,” Ali S. Khashan, PhD, from the University College Cork School of Public Health in Ireland, and colleagues wrote. “Given the increasing prevalence of HDP, partially owing to increasing levels of obesity, metabolic syndrome and advanced maternal age, collating the existing evidence of the association of HDP with neurodevelopmental outcome is timely.”

In their systematic review and meta-analysis, researchers searched clinical databases to examine the literature assessing the link between HDP and risk for neurodevelopmental disorders in offspring.

English-language cohort and case-control studies that reported HDP and neurodevelopmental disorders were included in the study. The investigators performed random-effects meta-analyses of estimated pooled odds ratios for HDP and ASD, and for HDP and ADHD, then reported stand-alone estimates for all other neurodevelopmental disorders, including cognitive functioning/developmental delay, behavioral outcomes and intellectual disability.

Researchers found that exposure to hypertensive disorders of pregnancy was associated with a small, but statistically significant, rise in offspring’s risk for autism and ADHD.

In total, 61 articles met inclusion criteria; 20 of which reported estimates for ASD, 10 of which reported estimated for ADHD and 31of which reported estimated for other neurodevelopmental disorders.

The results indicated that offspring exposed to HDP in utero were 35% more likely to have ASD and 30% more likely to have ADHD than unexposed children. Of the 20 studies that reported ASD estimates, 11 studies encompassing 777,518 participants reported a pooled adjusted OR for HDP of 1.35 (95% CI, 1.11-1.64). Of the studies that reported ADHD estimates, six encompassing 1,395,605 participants reported a pooled adjusted OR for HDP of 1.29 (95% CI, 1.22-1.36). Results of the subgroup analysis examining the preeclampsia/ADHD relationship and the preeclampsia/ASD relationship showed an OR of 1.28 (95% CI, 1.22-1.36) and an OR of 1.5 (95% CI, 1.26-1.78), respectively.

The literature examining the link between HDP and other neurodevelopmental, cognitive or behavioral outcomes was inconsistent, and the individual estimates reported in these studies were unreliable and the patterns of associations were unclear, according to the authors.

“Future research examining the association between HDP and neurodevelopmental outcomes needs to identify a comprehensive set of confounders to assess whether this association is causal or attributable to residual or unmeasured confounding,” Maher and colleagues wrote. “Future research could explore the association between HDP and mental disorders not included in this review to gain a greater understanding of the specificity of the effects of HDP.” – by Savannah Demko

Disclosures: The authors report no relevant financial disclosures.